Measuring the Impact of Sepsis

Every year, severe sepsis affects more than a million Americans. The number of cases is on the rise. It is the leading cause of death among patients in intensive care units and the most expensive condition treated in U.S. hospitals, but its impact on hospital mortality hasn’t been measured—until now.

Sepsis is a serious condition that results from an inflammatory response to infection—perhaps a localized infection stemming from the urinary tract, lungs, or abdomen. It can lead to vascular leaking and thrombosis, which impair blood flow, and cause vital organs to fail. Sepsis is most commonly caused by bacteria, but can also be caused by viruses, and it progresses rapidly. Patients with a compromised immune system, chronic illnesses, the elderly, and infants and children are most at risk.

In a study published in the Journal of the American Medical Association, Vincent Liu, MD, an intensivist at Kaiser Permanente, and his colleagues analyzed two inpatient cohorts to determine the impact that sepsis has on patient mortality. His conclusion: Depending on how sepsis is defined, at least 55% of hospital deaths were due in part to sepsis.

The research team studied 482,828 adult hospitalizations at 21 Kaiser Permanente Northern California (KPNC) facilities and 6,555,621 hospitalizations reported as part of the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS), a nationally representative sample of 1,051 hospitals. The researchers studied the medical records of patients with both explicit and implicit sepsis. Explicit sepsis included patients who were diagnosed with septicemia, sepsis, severe sepsis, or septic shock. Patients with evidence of infection and organ failure were considered to have implicit sepsis. The research team found that sepsis had contributed to at least one in every two to three deaths.

The research team also looked at the cost of treating sepsis and found that sepsis may account for as much as 24% of all hospital charges in the U.S.

The researchers pointed out that:

  • most of the patients in the study had sepsis at the time of admission.
  • many of the deaths could be directly linked to a preceding infection.
  • patients with less severe sepsis accounted for 56% of sepsis deaths; most of them were treated outside of the intensive care unit.

Going Forward
Because patients with less severe sepsis appear to account for the majority of sepsis-related deaths, the authors of the study believe that hospital mortality could be significantly reduced by improving standardized care for these patients. Research is focusing on improving clinicians’ ability to recognize sepsis in its earliest stages and on establishing the best treatment protocols. One study has already concluded that early identification of sepsis and administration of intravenous fluids and antibiotics during the first six hours of care are critical components in reducing mortality.

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